336426511-4-10-2025-56-AS-EMAN-DGNVJK-20250514162852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 04/10/2025
Date Signed: 04/10/2025 03:03:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241204103647

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	BLASIA LEE-LOLE		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 104	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Executive Director Andrea Perez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff financially abused resident in care.
Staff pushed resident in care.

INVESTIGATION FINDINGS:

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On 04/10/2025 at 02:00 PM, Licensing Program Analyst (LPA) Melody Brown met with Executive Director (ED) Andrea Perez at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office (RO) to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, records review and interviews with relevant parties.

First allegation: Staff financially abused resident in care. The investigation was conducted by LPA Melody Brown. The investigation consisted of observation and interviews with relevant parties. The first allegation indicates staff financially abused resident in care. During the investigation, LPA Brown was not able to obtain sufficient evidence to corroborate that staff financially abused resident in care. LPA Brown interviewed Resident # 1 (R1) and R1 indicated that staffs at the facility are not financially abusing R1. R1 added that there's no incident that a staff at the facility financially abused R1. Interview with seven (7) of seven (7) residents indicated that staffs at the facility ***Continuation in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20241204103647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 04/10/2025

NARRATIVE

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never financially abused them. Eight (8) of eight (8) staffs interviewed stated that they are not financially abusing their residents in care. Interview with eight (8) of eight (8) staffs revealed that there's no incident that happened at the facility that a staff financially abused R1. During the facility visit on 12/09/2024, LPA Brown did not find evidence that a staff financially abused R1.

Second allegation: Staff pushed resident in care. The investigation was conducted by LPA Melody Brown which consisted of observation, records review and interviews with relevant parties. During the investigation, LPA Brown was not able to obtain sufficient evidence to support that staff pushed resident in care. Interview with R1 revealed that there's no incident at the facility that a staff pushed R1. Moreover, R1 informed LPA Brown that while walking in the hallway, R1's shoes flipped and that resulted to R1's loss of balance. Interview with seven (7) of seven (7) residents indicated that there's no incident that a staff pushed them. Seven (7) of seven (7) residents stated that staffs at the facility are all respectful and caring and they will not push any resident at the facility. Eight (8) of eight (8) staffs interviewed reported that they did not push R1 at the facility and there's no incident that a staff pushed a resident in care.

Therefore, based on the evidence obtained during LPA Brown's investigation, there is insufficient evidence to prove that staff financially abused resident in care (Allegation #1), and staff pushed resident in care (Allegation #2) are UNSUBSTANTIATED at this time. Although the allegation of staff financially abused resident in care (Allegation #1), and staff pushed resident in care (Allegation #2) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to ED Andrea Perez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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